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Adult Lang Disorders > Weeks 1-3 > Flashcards

Weeks 1-3 Flashcards

1
Q

What is language

A

An abstract system of symbols combined by the use of grammatical rules that allows for the sharing of meaning within a social context

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2
Q

What is communication

A

The transmission of info between 2 beings (human or nonhuman); can include verbal, body lang, gestures, nonverbal noises and linguistic or non linguistic factors

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3
Q

What is speech and is it the same as language

A

Speech is NOT the same as language

Speech: motoric verbal means of communicating (articulation, voice, fluency)

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4
Q

True or false: acquired language and cognitive-communicative disorders may arise from injury to brain

A

true

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5
Q

True or false: acquired speech disorders occur to damage below level of cortex - spinal cord, cranial nerves, spinal nerves and peripheral body

A

true

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6
Q

What are the 2 cell types of nervous system

A

neurons : dendrites, cell body, axon, terminal ending and synapse; “communication cell”

Glial cells: provide axon myelination; “helper cells”

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7
Q

Gray matter: ______

White matter: _______

A

Gray matter = cell bodies and dendrites

White matter = myelinated axons

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8
Q

In CNS: nuclei is _______, except basal ganglia

In CNS: tracts, fasciculi are ______

A

Nuclei = gray matter

Tracts & fasciculi = white matter

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9
Q

Why is myelination important for axons

A

Myelination on axon carries the signal with rapid speed

Demyelinated axons lead to MS

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10
Q

Name the 4 lobes of cortex and which are more important for language

A

Frontal*
Parietal*
Temporal*
Occipital

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11
Q

Language is housed in which hemisphere

A

Left

right hemisphere = melody, intonation

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12
Q

What is the cortex

A

the cerebral cortex is the outermost layer of the brain, made up primarily of gray matter. It is the most prominent visible feature of the human brain → the cortex is the wrinkled convoluted surface of cerebrum

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13
Q

What are Brodmann’s areas

A

The structural differences of the cortex correlate to functional differences

Language → phonological and grammatical processing → housed in 44 and 45

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14
Q

Association cortex vs primary cortex

A

Primary Cortex:
direct processing of primary sensory or motor info.
Performs the actual task of the region.

Association cortex:
Most of brain made up of association cortex
Where modifications occur → analyze, recognize and act on sensory input
Usually positioned adjacent to primary cortex
plans & integrates info for the primary area.

Info is received from sensory cortex → then to primary cortex for perception → then to association cortex to ID whatever that we’ve perceived

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15
Q

Where is the first cortical location where sensory experience is received

A

Primary auditory cortex

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16
Q

Where in the primary cortex is motor command initiated

A

Primary motor cortex

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17
Q

Unimodal vs multimodal

A

Unimodal: usually adjacent to primary area; recognition using one sense

Multimodal: integrating senses

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18
Q

Name the 3 white matter tracts and their purpose

A

Projection tracts: interconnect primary cortical areas (primary motor and primary sensory) to deeper structures

Association tracts: are the most numerous and interconnect regions of the cortex within the same hemisphere

Commissural tracts: interconnect homologous (having the same relation, relative position) areas in the left and right hemispheres; tracts crossing b/w left and right hemis

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19
Q

Name the association tract connecting Broca’s and Wernicke’s areas

A

Arcuate fasciculus

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20
Q

What is decussation

A

Term used to describe a crossing of information at the midline

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21
Q

Why is continuous blood supply important for the brain

A

Must have continuous flow of blood → neural cells die quickly without

Once neural cell die, they are not regenerated

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22
Q

What are the 3 cerebral arteries providing blood to cortex (language and cognition are cortical functions)

A

Anterior cerebral artery (ACA)
Middle cerebral artery (MCA)
Posterior cerebral artery (PCA)

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23
Q

Which 2 cerebral arteries are important for language and cognitive communicative functioning

A

ACA and MCA

MCA provides blood supply to specialized language center of the brain in left hemisphere → Broca’s and Wernicke’s

ACA provides blood to prefrontal area → judgment, inhibition, high level cognitive processes, problem solving, planning

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24
Q

What is watershed zone

A

Areas b/w 2 cerebral arteries in the cortex

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25
Q

What is an ischemic stroke and the 4 types

A

Ischemic stroke = insufficient blood supply caused by blood clots

4 types:
Thrombosis: localized buildup of fatty plaques/platelets causing occlusion

Embolism: blockage in blood vessel caused by traveling clot, air bubble, etc.
Transient ischemic attack (TIA): “mini stroke”; stroke symptoms resolve → blood flow returns causing no cell death
Lacunar strokes: small blockages of blood vessels occurring in thalamus or basal ganglia; causes cell death appearing as tiny dots on scan; causes motor sensory deficits

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26
Q

What is the penumbra

A

Surrounding area of living tissue next to cell death caused by CVA

Tx goal → increase blood flow to area to form new connections that were lost

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27
Q

What is hemorrhagic stroke and the 3 types

A

Hemorrhagic stroke = brainbleed

3 types:
Intracerebral: common cause high blood pressure; occurs in cranial tissue

Extracerebral: related to aneurysm; occurs in meningeal tissue

space-occupying lesions: squeeze neural tissue against cranium; common cause aneurysm

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28
Q

Short term and long term treatments for stroke

A

ST: goal is to save tissue of penumbra with medical treatment to restore brain function

LT: rehab

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29
Q

What is tPA and when is it used

A

Tissue plasminogen activator (tPA) is administered for occlusive ischemic strokes (blood clots)

It breaks down clots

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30
Q

What is perisylvian

A

Area of brain responsible for language

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31
Q

What are the perisylvian language areas of brain

A

Broca’s area (BA 44, 45; frontal lobe): expressive language —> language production and structure of language: like MLU, fluency, phonology, syntax, grammar, etc

Wernicke’s area (BA 22; temporal lobe): (auditory) receptive language —> language comprehension and understanding
Angular and supramarginal gyri: implications for reading and writing and spelling

Superior longitudinal fasciculus and arcuate fasciculus: white matter association tracts interconnecting the 4 cortical lobes

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32
Q

The patient has difficulty with _____ when the arcuate fasciculus is damaged

A

Repetition tasks

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33
Q

Neuroimaging allows for visualization of structure aka _______ and function aka ________

A

Structure → anatomy

Function → physiology

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34
Q

Location of Broca’s area

A

Inferior frontal gyrus

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35
Q

Location of Wernicke’s area

A

Posterior superior temporal gyrus

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36
Q

3 types of structural neuroimaging

A

CT
Cerebral angiography
MRI

These have good spatial resolution but not temporal
Identifies anatomical difference in healthy brains vs patients

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37
Q

2 types of functional neuroimaging

A

PET
fMRI
(EEG)
(MEG)

Identifies brain functioning during activity

Has good spatial AND temporal resolution

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38
Q

Pros and cons of structural neuroimaging: CT

A

CT scans: High spatial resolution allows us to see details of brain structure

Pros: 
able to distinguish between ischemic (blockage) or hemorrhagic stroke (bleed)
Widely available; less expensive 
Cons: 
high radiation exposure
Poorer spatial resolution than MRI
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39
Q

CT research results

A

Aphasia and patients with RH and LH damage were more severely affected than those with unilateral LH damage

Damage associated with Broca’s → transient speech impairment (not as severe, more easily changing)
Broca’s area and white matter → chronic nonfluent speech following stroke (more severe, more chronic long-term impairment)

40
Q

Pros and cons of structural neuroimaging: Cerebral angiography

A

Able to view vascular abnormalities in cerebral blood vessels

Pros: detects hemorrhage, aneurysm, gives indication of stroke risk
Cons: radioactive dye, invasive, x-ray exposure

41
Q

Pros and cons of structural neuroimaging: MRI

A

Better spatial resolution than CT

Water concentration varies depending on tissue type (gray vs white)
MRI can distinguish between tissue densities based on water concentration
Pros: excellent spatial resolution; no radiation; abel to see areas of cortical thickness
Cons: expensive, not appropriate for all patients

42
Q

MRI research findings

A

LH stroke → with MRI lesions in anterior portion of insula is a predictor of verbal apraxia (motor planning)→ concluded it was NOT Broca’s area

MRI found structural damage or decreased blood flow in Broca’s area is best predictor of speech/lang production

Spontaneous aphasia recovery immediately following injury is related to increased brain function in areas surrounding acute lesion

43
Q

Pros and cons of structural neuroimaging: DTI

A

Tractography technique with MRI: diffusion tensor imaging

Water moves freely along axon than across axon

DTI results show: damage to both anterior and posterior language zones may result in conduction aphasia → not just damage to AF

44
Q

What is functional neuroimaging

A

Seeks to understand the location or timing of task-dependent neural activity in the brain

Looks at changes over time → temporal resolution

45
Q

Pros and cons of functional neuroimaging: PET

A

Positron emission tomography (PET)

Pros: method of viewing neural regions during tasks with decent spatial resolution

Cons: radioactive tracer; reduced temporal resolution

46
Q

PET research findings

A

A study to determine hemispheric activity/compensation during language task found LH “activation” in preserved regions among stroke pts was very similar to that observed in healthy individuals (

RH brocea’s area homologue inactivation was related to poorer language performance

47
Q

Pros and cons of functional neuroimaging: fMRI

A

Functional magnetic resonance imaging

Measures change in magnetic field within brain during rest as compared with during task

Increased firing of neurons during task is related to need for more oxygen and glucose

Pros: no radioactive tracer, good spatial resolution
Cons: not a direct measure of neural activity, reduced temporal resolution, not appropriate for all pts

48
Q

PET research findings

A

Like PET, fMRI studies in aphasia focus on cortical reorganization after injury suggesting both RH and LH are important

49
Q

Stroke is a leading cause of serious ________ disability

A

long term

50
Q

Those who arrive at the hospital within _____ hours of first symptoms have less disability than those with delayed care

A

3 hours

51
Q

___% that fully recover after stroke

A

30%

52
Q

What populations are at high risk of TBI

A

Children and older adults with falls as the leading cause

53
Q

Stroke, TBI and AD have both ______ and _____ impact

A

Societal and personal impact → personal being the largest impact

54
Q

Therapy goal of neurogenic communication disorders and what two aspects need to be considered when planning treatment

A

Goal: Maintain worthwhile quality of life

Treatment: social context and clinical aspects

55
Q

Define impairment

A

Pathology; can be easily identified through testing

56
Q

Define disability

A

The consequences of the impairment on everyday life

57
Q

Define handicap

A

Value that the individual, family, community places on disability and the degree to which the individual is disadvantaged

Differences in individuals’ perception of disability and handicap should be identified and considered during assessment and intervention planning

58
Q

Name a few psychosocial barriers that may impact person’s life and recovery

A 
Mood and personality
Perceived support
Perception of stigma
Emotional turmoil
Self-esteem and identity
59
Q

Name a few common themes and stages of individuals with illness

A 
Coping strategies
Social support
Participant involvement in treatment decisions
Strain of trying to endure
Shock of institutionalization
Suffering and uncertainty of illness

It’s important to try to understand what the patient is going through

60
Q

What are some ways to practice a patient-centered approach

A

Inform → assessment
Respect -> patient preferences
Ask → goals of therapy; QoL
Educate → patients’ role and condition

61
Q

True/false: depression is a barrier to rehabilitation

A

TRUE

62
Q

Stages of emotional reaction to chronicity of illness

A 
Shock
Realization
Denial
Mourning
Adaptation
63
Q

Quality of life incorporates

A 
Physical health
Psychological health
Independence
Social relationships
Personal beliefs
64
Q

What is aphasia

A

Acquired neurogenic language disorder due to damage to left hemisphere

Language difficulty is primary

65
Q

What is pure aphasia

A

Can hear but can’t understand (poor auditory comprehension)
No motor planning/coordination difficulty
Not a change in cognition

Aphasia may co-occur with sensory, motor and cognitive impairment

66
Q

What is sensory aphasia

A

Deficits in language comprehension (receptive language)

Posterior injury

67
Q

What is motor aphasia

A

Deficits in language production (expressive language)

Not motoric physical production

Anterior injury

68
Q

What is crossed aphasia

A

Language impairment due to damage to nondominant hemisphere → typically right hemisphere in most people

69
Q

true/false - there is only one theory of aphasia

A

False - there are many - no single unifying theory of aphasia

70
Q

theory vs model

A

Theory - statement/idea

Model - tests the theory’s statement

71
Q

What is the goal of aphasia theories and models

A

To further understand aphasia and language by studying pathology

72
Q

Theory: classical associative connectionist paradigm

define

A

Dominant theory for assessments

Discrete centers of brain (anatomy) responsible for language (physiology) interconnected by pathways to facilitate info flow b/w areas

73
Q

Theory: classical associative connectionist paradigm

What is the anatomy and connecting physiology

A

Posterior language center: Wernicke’s area → language comprehension (receptive language)

Anterior language center: Broca’s area → language production → expressive language

74
Q

Name the pathway between posterior and anterior centers

A

Arcuate fasciculus

75
Q

Theory: classical associative connectionist paradigm

What are the limitations

A

Links broad aphasic symptoms to discrete structures → doesn’t’ always match up through observations

Gave rise to “cognitive neuropsychological models” for understanding aphasia however these models are based on function and do not attach function to specific neural regions

76
Q

What are two commonly used assessments for aphasia

A

Boston Diagnostic Aphasia Classification (BDAE)

Western Aphasia Battery (WAB)

Agreement b/w these two assessments is 27%

77
Q

What are the two main classification criteria for aphasia

A

Fluency (utterance length)
Comprehension

Helps to drive treatment methods

78
Q

Pros and cons for aphasia classification

A

Pros
Pattern of brain injury and behavioral effects
Helps to drive treatment

Cons
Doesn’t account for individual variation
Brain functions as holistic integrated unit → no discrete language centers

Ability to do or not do a task is more meaningful than classification

79
Q

S/S of aphasia: Paraphasias (word choice errors)

Verbal/semantic

A

Word errors semantically related to target word

“Cup” → “bowl” (similar meaning)

80
Q

S/S of aphasia: Paraphasias (word choice errors)

Literal/phonemic

A

Word errors phonemically related to target word

“Cup” → “Cat” (/k/ word initial)

Words are related in production

81
Q

S/S of aphasia: Paraphasias (word choice errors)

Neologism and jargon

A

Newly created made up words with no content eg “slunker” “glimpop”

Jargon is neologism at conversational level

82
Q

S/S of aphasia: Paraphasias (word choice errors)

Stereotypies and recurrent utterances

A

Stereotypies: non-propositional, not novel; ;produced constant repetition of sound segment “toe-no”; produced with correct prosody

Recurrent utterances: “ya know” repeated

Sometimes there’s a bust of in freq in emotional settings

83
Q

S/S of aphasia: Paraphasias (word choice errors)

Perseveration: Atypical repetition of words, topics after that stimulus has ceased

A

When patient hears and produces target word and then used that target word for all following answer; knows they are saying incorrect word

First said banana and now calls all breakfast items banana

84
Q

Define agrammatism

A

Reduced function words, reliance on content words

Typically seen in impaired fluency

85
Q

What is BDAC

A

Boston Diagnostic Aphasia Classification

Based on classical associative connectionist theory with modifications

8 parameters of speech and lang production

Classifies 7 types of aphasia

30-80% of patients are easily placed into classifications

86
Q

Describe the classifications of Werncikes and Brocas according to BDAC

A

Wernickes:
Higher score: articulation, phrase length(fluency), prosody

Lower score: paraphasias (word errors), anomia (word finding), sentence repetition, comprehension

Brocas:
Higher score: paraphasias (word errors), anomia (word finding), sentence repetition, comprehension

Lower score:articulation, phrase length (fluency), grammatical form, prosody

87
Q

What is anomia

A

Common throughout all types of aphasia
Impairment in lexical retrieval (naming)
Use of pause filled reducing fluency

88
Q

According to BDAE which aphasia type has low comprehension - Wernickes and conduction aphasia

A

Wernickes

However these 2 conditions have very different underlying biological mechanisms and patterns of language and communication so the fact that this test is only saying that auditory comprehension scores differentiate b/w the 2 is a limitation

89
Q

What is WAB

A

Western Aphasia Battery

Aphasia assessment informed by BDAE

8 aphasia classifications based on performance on 4 parameters

90
Q

What are the 4 parameters of WAB

A

Fluency
Auditory verbal comprehension
Repetition ability
Naming/word finding

91
Q

What are the pros and cons of WAB

A

Pro:
Classifies nearly 100%
Increased reliability of testing due to direct instruction in scoring and test administration (test/retest)

Cons:
Based on same framework as BDAE but has different parameters adn classifications
Agreement in classification between BDAE and WAB is 27%

92
Q

What is fluent aphasia

A

Posterior injury (wernickes)

Poor auditory comprehension
Speech is naturalistic and fluent
Normal utterance length
Lack of agrammatism (reduced function words)

93
Q

What is non-fluent aphasia

A

Anterior injury (Brocas)

Good auditory comprehension 
reduced fluency (Utterance length is short and lots of pausing)
Agrammatism (reduced function words)
94
Q

True or false: some studies show damage to Broca’s is not a requirement for non-fluency

A

true

95
Q

What is best approach for classifying aphasia (3 approaches)

A

Describe signs and symptoms of that particular individuals language impairment

Describe the impact on the different language domains (phonology, morphology, syntax, semantic, pragmatics)

Describe co-occurring impairments that may impact rehab

96
Q

what is cognitive neuropsychological models and the 4 stages

A

single word processing studies help identify where the breakdown is in auditory and visual word processing by examining different stages of language comprehension and production.

Not representing regions of brain —> instead there are cognitive modules.

the independent stages help us to study disorders at various stages of impairment

4 stages:

  • phonological (hearing) and orthographic (seeing) input lexicon
  • semantic system –> gives meaning and context
  • phonologic (spoken) and orthographic (written) output lexicon –> finding phonemic meaning
  • written or spoken form —> cueing with phonemic cue can help with this stage
97
Q

cognitive neuropsychological models

pros and cons

A

pro: help inform clinical intervention with model based theory; provide cognitive baseline for observations

cons:
- are modules truly independent or is there overlap?
- often based on single studies –> is it able to generalize
- doesn’t relate info back to neurobiology and regions of brain

Adult Lang Disorders (4 decks)

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